Member Case Study: Muscle Cramping

author : AMSSM
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Member Question from dbrard001
I have been training regularly since March for an Olympic distance event (Disney Triathlon on 9/23). I, like many new triathletes, have struggled improving my performance on the run and have been careful to not increase my distances too much.

 

Recently during a brick workout (1 hour bike, 30 minute run) I felt my lower thigh begin to cramp up. It was close to 90 degrees outside, but I felt I had adequate fluids in me. I took electrolyte tablets before the bike and again before the run along with plenty of water (Endurolyte by Hammer Nutrition) and kept a bottle of the Heed mixture (also from Hammer).  My question is what are some tips to avoid the muscle cramps (which normally hit me in the run portion). How can I best prepare my body to perform without cramping?

Answer from John Su, MD

Member AMSSM

Muscle cramps are a common complaint of triathletes. By definition, a cram is a sudden, painful, and involuntary contraction of muscle. "Cramp" is derived from the old German root word for “squeeze’ or ‘pinch.’

While cramping is very common in the elderly, it is also quite common in the athletic population. Usually it is related to a forceful contraction, is acutely painful, and results in a visible and palpable contraction.

The cause of muscle cramps is not entirely understood. While there are rare reasons for muscle cramping including drug toxicities or hereditary neuromuscular disorders, the majority of muscle cramps are likely related to a combination of neuromuscular fatigue, energy depletion, dehydration, and electrolyte abnormalities.

Despite the common assumption that it is purely a dehydration or electrolyte deficiency problem, a study in Ironman triathletes found no correlation between cramping and depletion in electrolytes such as calcium, magnesium, potassium, or sodium. Another study of ultra-marathon runners found hydration status not to correlate with cramping. These studies further suggest that neuromuscular fatigue is a more primary cause of muscle cramping.

Acute stretching and gentle massage can be helpful, but prevention begins with adequate training. Studies suggest that fitness is more beneficial than an increase range of motion beyond function -- that excess stretching may even diminish performance. Fitness equates to the neuromuscular adaptations to sympathetic stimulation and efficient use of energy stores. When muscles are depleted of energy stores and continued to be excited, the inability for these overtaxed muscles to relax results in
cramping. In some individuals, dehydration or electrolyte depletion may play a role but specific testing would be useful. In these individuals, if lack of fitness has been ruled out, trials of electrolyte replacement in various concentrations may be of benefit.

In triathlon, common scenarios of cramping occur during the swim where lack of lower leg muscle flexibility, possible blood flow constriction due to poorly fitting wetsuits, and the neuromuscular irritation from icy cold water can cause problems. Another scenario is the transition from the bike to run, where the body's glycogen stores are diminished and suddenly the athlete needs to change muscle groups. Neuromuscular stimulation is high with the excitement of rushing through transition.

The key to prevention is to be adequately trained for that particular race distance and/or to pace accordingly to your fitness – i.e., slow down.

If cramping persists or occurs with minimal activity, one should seek medical care.

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date: November 4, 2007

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AMSSM

The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

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avatarAMSSM

The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

FIND A SPORTS MEDICINE DOCTOR

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